Low Sugar-sweetened Beverages Research Articles

Abstract MP42: Intakes of Sugar-Sweetened Beverages and Total Sugars are Associated with Higher Triglycerides in a Multi-Ethnic Sample of Children

Background: Intakes of sugar-sweetened beverages (SSB) and added sugars have been targeted in efforts to reduce childhood obesity and cardiovascular disease risk factors in children. Although evidence is sparse in children, overconsumption of SSB and added sugars has been linked to greater dyslipidemia in adults. Objectives: To examine the association between intakes of SSB, added sugars, and total sugars, with blood lipids in a multi-ethnic sample of children with prevalent obesity. Methods: In this cross-sectional study, we examined associations between intakes of SSB, added sugars, and total sugars with high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG) in a sample of 276 children aged 8-15 y (mean age 11.8 y; 39% white, 14% black, 16% Hispanic/Latino, 12% Asian, and 19% multi-racial/other) with prevalent overweight/obesity (45% with ≥85 th BMI percentile and 25% with ≥95 th ). Percentage of daily calories from SSB, as well as intakes of added sugars (tsp) and total sugars (g), were estimated using the 2004 Block Food Frequency Questionnaire for Children. HDL-C and TG were obtained from a fasting blood sample. Percentage of calories from SSB, added sugars, and energy-adjusted total sugars were dichotomized at their upper tertile cut-points, specifically, at 7%, 13 tsp, and 116 g, respectively, creating two intake categories for each dietary exposure. ANCOVA was used to analyze the data; covariates were age, sex, race/ethnicity, obesity, total calories, and intakes of saturated fat and dietary fiber. TG was log-transformed prior to analysis; low HDL-C was defined as ≤45 mg/dL and borderline/high TG, as ≥75 (aged ≤9 y) or ≥90 mg/dL (≥10 y). Results: Median daily intake of total sugars was 94.2 g, 47% of which was derived from added sugars (median: 9.9 tsp, range: 1-76 tsp). Only 12% of children followed the American Heart Association calorie-specific recommendations for intake of added sugars. Median contribution of SSB to total calories was 4.4% (range: 0 to 51%), and SSB calories contributed 36% (range: 0 to 100%) of calories from added sugars. Both low HDL-C and borderline/high TG were prevalent (26-27% overall) and were more common in children classified as obese (61% and 53%, respectively) than in those who were not obese (16% and 17%, respectively, P<0.0001 for each); however, intakes of SSB, added sugars, and total sugars did not differ with obesity. In multivariate-adjusted models, higher TG was associated with high intakes of SSB (75.3 vs. 67.6 mg/dL, P=0.04) and total sugars (76.5 vs. 67.0 mg/dL, P=0.01), while the association with added sugars was not significant. There were no associations with HDL-C. Conclusions: Among children with prevalent obesity, higher intakes of SSB and total sugars were associated with higher TG concentrations, but not with lower HDL-C. Further research is needed on the health implications of lower SSB and sugar intakes in diverse samples.

Executive Summary: Heart Disease and Stroke Statistics—2014 Update

Author(s): Go, Alan S; Mozaffarian, Dariush; Roger, Veronique L; Benjamin, Emelia J; Berry, Jarett D; Blaha, Michael J; Dai, Shifan; Ford, Earl S; Fox, Caroline S; Franco, Sheila; Fullerton, Heather J; Gillespie, Cathleen; Hailpern, Susan M; Heit, John A; Howard, Virginia J; Huffman, Mark D; Judd, Suzanne E; Kissela, Brett M; Kittner, Steven J; Lackland, Daniel T; Lichtman, Judith H; Lisabeth, Lynda D; Mackey, Rachel H; Magid, David J; Marcus, Gregory M; Marelli, Ariane; Matchar, David B; McGuire, Darren K; Mohler, Emile R; Moy, Claudia S; Mussolino, Michael E; Neumar, Robert W; Nichol, Graham; Pandey, Dilip K; Paynter, Nina P; Reeves, Matthew J; Sorlie, Paul D; Stein, Joel; Towfighi, Amytis; Turan, Tanya N; Virani, Salim S; Wong, Nathan D; Woo, Daniel; Turner, Melanie B; American Heart Association Statistics Committee and Stroke Statistics Subcommittee

Clustering of multiple lifestyle behaviours and its association to cardiovascular risk factors in children: the IDEFICS study

Individual lifestyle behaviours have independently been associated with cardiovascular diseases (CVD) risk factors in children. This study aimed to identify clustered lifestyle behaviours (dietary, physical activity (PA) and sedentary indicators) and to examine their association with CVD risk factors in children aged 2-9 years. Participants included 4619 children (51.6% boys) from eight European countries participating in the IDEFICS cross-sectional baseline survey (2007-2008). Insulin resistance, total cholesterol/high-density lipoprotein cholesterol ratio, triglycerides, sum of two skinfolds and systolic blood pressure (SBP) z-scores were summed to compute a CVD risk score. Cluster analyses stratified by sex and age groups (2 to <6 years; 6-9 years) were performed using parental-reported data on fruit, vegetables and sugar-sweetened beverages (SSB) consumption, PA performance and television video/DVD viewing. Five clusters were identified. Associations between CVD risk factors and score, and clusters were obtained by multiple linear regression using cluster 5 ('low beverages consumption and low sedentary') as the reference cluster. SBP was positively associated with clusters 1 ('physically active'; β=1.34; 95% confidence interval (CI): 0.02, 2.67), 2 ('sedentary'; β=1.84; 95% CI: 0.57, 3.11), 3 ('physically active and sedentary'; β=1.45; 95% CI: 0.15, 2.75) and 4 ('healthy diet'; β=1.83; 95% CI: 0.50, 3.17) in older boys. A positive association was observed between CVD risk score and clusters 2 (β=0.60; 95% CI: 0.20, 1.01), 3 (β=0.55; 95% CI: 0.14, 0.97) and 4 (β=0.60, 95% CI: 0.18, 1.02) in older boys. Low television/video/DVD viewing levels and low SSB consumption may result in a healthier CVD profile rather than having a diet rich in fruits and vegetables or being physically active in (pre-)school children.

Disparate Advertising of Sugary Drinks: An Analysis of Beverages Promoted in Circulars from Grocery Stores in High- and Low-Income New York City Zip Codes

Background: The consumption of sugar-sweetened beverages (SSBs) has been associated with an increased risk of chronic disease including obesity, type 2 diabetes, and coronary heart disease. A correlation between low socioeconomics (SES) status and higher SSB intake has also been established. Objective: The objective of this study was to analyze the calorie content and added sugar in beverages advertised in circulars of grocery stores in high- and low-income New York City zip codes. Methods: Across a two-month period, we analyzed various nutritional characteristics of beverage products advertised on the front page of online circulars from grocery stores in 5 low- and 5 high-income New York City zip codes. Results: Three-fourths of beverage products for sale in circulars from low-income zip codes were sugar-sweetened (74.4%) as compared with just over one-third advertised in those from high-income zip codes (35.7%). Conclusion: High-calorie, sugary beverages are being marketed and priced to sell by grocery stores serving low SES populations with high SSB consumption patterns. Health education and promotion efforts that grocery stores can implement to contribute to chronic disease prevention are discussed.

Sugary beverage intakes and obesity prevalence among junior high school students in Beijing - a cross-sectional research on SSBs intake.

Excessive consumption of sugar-sweetened beverages (SSBs) may increase the risk of obesity. Data in regards to the consumption of SSBs is insufficient in the Chinese population, especially in middle school students experiencing rapid nutritional transition. We aimed to describe the consumption of SSBs among junior high school students and explore the relationship between SSB intake and adolescents' overweight/obesity in Beijing. This was a cross-sectional study under which 322 (46%) male and 380 (54%) female (age 11-15 y, median 13 y) were recruited from two middle schools of Xicheng District in Beijing. All subjects completed a questionnaire and 24-hour dietary recall for 3 consecutive days. Prevalence of overweight was 21.1% in males and 11.6% in females. Prevalence of obesity was 22.7% in males and 10.3% in females. Of the students, 7.7% consumed SSBs at least once per day. Students whose storage of SSBs at home is more than 1 type are more likely to consume higher quantities of SSBs everyday (p<0.001). After adjusting for confounding factors, OR of high SSBs intake group versus low SSBs intake group was 2.6. Students whose parents had a higher BMI had a higher risk of overweight/obesity (OR=1.13, p=0.007). Among middle school students in Beijing, prevalence of obesity is more severe than that of overweight. Sugar-sweetened beverages have been the most popular drinks, and consumption of SSBs has a positive association with levels of overweight/obesity among male students.

Effects of breastfeeding and low sugar-sweetened beverage intake on obesity prevalence in Hispanic toddlers

Few studies have examined the independent and additive effects of breastfeeding (BF) and sugar-sweetened beverage (SSB) intake in early life on overweight and obesity prevalence. The objective was to assess the effects of BF and SSB intake on the prevalence of overweight and obesity in Hispanic toddlers. Nutrition data were collected via phone surveys with caregivers of 1483 Hispanic children (2-4 y of age) from the Los Angeles County Women, Infants, and Children (WIC) program. BF history at 2-4 y of age was categorized as follows: no BF, >1 wk to <6 mo BF, 6 to <12 mo BF, and ≥12 mo BF. SSB intake at 2-4 y of age was categorized as follows: high SSB (≥2 SSBs/d), mid SSB (1 SSB/d), and no SSB. The height and weight of the children were measured by WIC staff and stored in the Integrated Statewide Information System. Binary logistic regressions assessed the effects of BF and SSB categories on overweight and obesity prevalence. In comparison with the no-BF participants, the odds of obesity were lower in the ≥12-mo-BF participants (OR: 0.55; 95% CI: 0.37, 0.83; P = 0.004). In comparison with high-SSB participants, the odds of obesity were lower in the no-SSB participants (OR: 0.69; 95% CI: 0.47, 1.00; P = 0.047). In comparison with the combined no-BF/high-SSB participants, the odds of obesity were lower in the ≥12-mo BF/no-SSB participants (OR: 0.39; 95% CI: 0.19, 0.80; P = 0.01). The results suggest that BF for ≥1 y and low SSB intake during the toddler years can have profound effects on reducing the prevalence of obesity in Hispanic toddlers.

Relationship Between Insulin Resistance–Associated Metabolic Parameters and Anthropometric Measurements With Sugar-Sweetened Beverage Intake and Physical Activity Levels in US Adolescents

To evaluate the relationship between insulin resistance-associated metabolic parameters and anthropometric measurements with sugar-sweetened beverage intake and physical activity levels. A cross-sectional analysis of the National Health and Nutrition Examination Survey data collected by the National Center for Health Statistics. Nationally representative samples of US adolescents participating in the National Health and Nutrition Examination Survey during the years 1999-2004. A total of 6967 adolescents aged 12 to 19 years. Sugar-sweetened beverage consumption and physical activity levels. Glucose and insulin concentrations, a homeostasis model assessment of insulin resistance (HOMA-IR), total, high-density lipoprotein, and low-density lipoprotein cholesterol concentrations, triglyceride concentrations, systolic and diastolic blood pressure, waist circumference, and body mass index (calculated as weight in kilograms divided by height in meters squared) percentile for age and sex. Multivariate linear regression analyses showed that increased sugar-sweetened beverage intake was independently associated with increased HOMA-IR, systolic blood pressure, waist circumference, and body mass index percentile for age and sex and decreased HDL cholesterol concentrations; alternatively, increased physical activity levels were independently associated with decreased HOMA-IR, low-density lipoprotein cholesterol concentrations, and triglyceride concentrations and increased high-density lipoprotein cholesterol concentrations. Furthermore, low sugar-sweetened beverage intake and high physical activity levels appear to modify each others' effects of decreasing HOMA-IR and triglyceride concentrations and increasing high-density lipoprotein cholesterol concentrations. Sugar-sweetened beverage intake and physical activity levels are each independently associated with insulin resistance-associated metabolic parameters and anthropometric measurements in adolescents. Moreover, low sugar-sweetened beverage intake and high physical activity levels appear to modify each others' effects on several health-related outcome variables.